Back to Reality: A Critique of Postmodern Theory in Psychotherapy

As a graduate student in psychology, I found Dr. Held's book to be extremely helpful for sorting out the ideological positions (or biases) that underlie contemporary debates about psychotherapy -- narrative therapy, constructivism and social constructionism, etc.. I recommend this book to anyone interested in gaining fresh insight into, and deeper understanding of, the enterprise of psychotherapy. I just have to add, too, the observation that Dr. Held also wrote an entertaining pop psych book, Stop Smiling, Start Kvetching, that certainly demonstrates her breadth as a psychologist !!

Barbara Held says in the Preface that 'This is not a book about how to do psychotherapy. It is a book about how to think about psychotherapy -- more precisely, how to think as clearly as possible about the theory and practice of psychotherapy.' Written while a visting scholar at Tufts in the early 90s, this book examines and critiques one of the fundamental philosophical assumptions of the PoMo movement -- the denial of external reality and the consequent disappearance of the individual (who, after all, is ostensibly the subject in therapy). I found her work significant because she clearly shows how philosophical theory inescapably informs psycho-praxis. As the title suggests, Held makes a good case for what she calls a "modestly realist" epistemology, and incisively deploys Edward Pols (himself a first-rank thinker in Philosophy of Mind) to highlight the serious theoretical problems in a constructivist-only position. If you're even vaguely interested in the philosophical issues behind psychotherapy, or like the rest of us concerned about the divergent and disjunct anthropologies behind various 'schools' of psychology, then this book is for you. Particularly exciting is her ably-argued case for a moderate-realist epistemology. I view this work is a significant step towards the recovery of philosophy, which for too long has collapsed ontology into epistemology and then lapsed, as the PoMos do, into solipsism.

An important book about the dilemma between realism/antirealism within and between different schools of psychotherapies. The author builds in her book a professional philosophical analysis of the dilemma. She succeeds to show important weak points in the basic assumptions of s.c. narrative or constructionistic approaches. But she can, however, make both philophical and clinical bridges between the gap by what she calls as modest realism. - Within the field of family therapy the book is highly useful e.g. in the debate between the structural and narrative schools (or, as Minuchin calls it: interventionist versus restrained therapy). The book opens up possibilities for a systematic philosophical analysis of these dilemmas in stead of more ideological emphases.

After the first few pages of this book I could sense I was in for a treat. Barbara Held gets her teeth into a meaty subject with great seriousness and clarity, and humbly explores the various implications and blind spots in narrative therapy, constructivism and social constructionism. Comparing postmodern approaches to therapy with ÒeclecticÓ approaches, Ms.Held notes that they are both motivated by the recognition that no one theory can adequately accommodate the complexities of the human experience, and both attempt to keep their practices individualized and systematic. One of the differences is that the narrative approach tends to be more successful in achieving an individualized therapy and eclectic approach has more success at being systematic. As Ms. Held tells us, Òjust because each therapy case is unique and individual in some ways does not mean it is unique and individual in all ways.Ó More than this though, she skillfully points out the inevitable contradictions in narrative therapies such as the denial of individuality as a reality, while seeing the construction of such notions as an individual accomplishment. Ms.Held is critical of these lapses in consistency and a major theme throughout the book is how narrative therapists (and she refers to White, Epstein, de Shazer, Anderson & Goolishian and Gergen among others) make inevitable reference to an Òextra-linguistic, independent realityÓ while simultaneously denying such objectivity in favor of co-constructed stories that lead to quotes like Òthe way a life is told determines how it is livedÓ (Omer & Stenger, 1992). Ms.Held points out that the constructionistÕs assertion that there are actually dominant discourses that determine relationships, is the unwitting evidence that they are not quite as anti-realist as they like to think they are. In other words, narrative therapists are making explicit claims about the causes of problems that we cannot, according to their own doctrine, know. She sees this troubling oscillation as reflecting a Òserious struggleÓ over an eternally defiant problem Ñthe nature of knowing, or epistemology. Ms.Held attempts to rectify this oscillation and concludes by suggesting that we may never achieve a truly anti-realist position. Ms.Held assumes that there is an independent, real world and uses Edward PolsÕ description of active knowing (1992) to support her view. She believes we can directly know entities such as rocks, birds, trees, stories, scientific theories and relationships through Òrational awarenessÓ qualifying this by saying the knower Òengages the real and attains it.Ó She quotes from Pols extensively and offers his thoughts as the better alternative to postmodern antirealism, claiming that social constructionists fail to make the distinction between acts of direct knowing on the one hand and acts of theory-building on the other. I found myself agreeing with the postmodern philosophers that Pols attacks, especially in proposing that